Retropharyngeal and Parapharyngeal Abscesses in Children

Researchers from University of Louisville School of Medicine and University of Tennessee Health Science Center conducted a retrospective study to describe the epidemiology and hospital experience of US children diagnosed with parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA). For the study, the researchers identified cases of RPA and PPA using ICD-9 codes in the Kids’ Inpatient Database (KID) for 2003, 2006, 2009, and 2012. KID includes data on inpatient pediatric admissions from dozens of states each year. For cases of RPA and PPA identified in KID, data on age, gender, management (surgical drainage or nonsurgical treatment), length of stay (LOS), and hospital charges were abstracted. Census data were used to generate nationally representative estimates of the incidence of RPA and PPA. Changes in incidence and rates of surgical management of both diagnoses during the 4-year study period were assessed statistically. Rates of RPA and PPA in children in different age groups were evaluated. In addition, costs and LOS for patients managed with surgical treatment or without surgery were compared. During the 4-year study period there were 2,685 hospital discharges for PPA and 6,233 for RPA among individuals ≤20 years old; more boys were affected than girls across all age groups. Both RPA and PPA were more common from December to May in each of the study years. The incidence of RPA increased from 2.98 per 100,000 in 2003 to 4.10 per 100,000 in 2012 (P < .01), while the rate for PPA crested at 1.49 per 100,000 in 2006 and then plateaued. RPA and PPA were more common in those <5 years than among older children. Overall, 58.1% of children with PPA were treated with surgical drainage versus 46.7% of those with RPA (P < .001). During the study period the rate of surgical management for children with RPA decreased significantly but was stable among those with PPA. Hospital charges were approximately twice as high for children with both RPA and PPA treated surgically than in those managed without surgery (P < .001 for both RPA and PPA); median LOS was also significantly longer for those managed surgically (4 days vs 3 days for those treated without surgery for both RPA and PPA). The authors conclude that hospitalization rates for children with RPA are twice as high as for PPA. Surgical management of both RPA and PPA was associated with higher costs and longer LOS.